{"id":533,"date":"2010-04-01T12:05:18","date_gmt":"2010-04-01T16:05:18","guid":{"rendered":"http:\/\/parkinson.netfirms.com\/epp_e\/?p=533"},"modified":"2010-04-01T12:05:18","modified_gmt":"2010-04-01T16:05:18","slug":"parkinsons-much-more-than-a-movement-disorder","status":"publish","type":"post","link":"https:\/\/archiveparkinson.thedev.ca\/fr\/parkinsons-much-more-than-a-movement-disorder\/","title":{"rendered":"Parkinson\u2019s much more than a movement disorder"},"content":{"rendered":"

Parkinson\u2019s disease is usually considered to be a movement disorder characterized by tremor, rigidity, slow movement or poor balance. Yet when many people with Parkinson\u2019s look back they can point to early changes in areas unrelated to movement, such as, loss of smell, lack of motivation, tiredness, and slower responses when answering questions. A visitor to the Parkinson Society Canada web site, archiveparkinson.thedev.ca, who experienced these kinds of changes before the diagnosis recently asked: \u201cWhy isn\u2019t there more information out there for doctors and the general public about the subtle signs of Parkinson\u2019s so they can be monitored and diagnosed earlier?\u201d<\/strong><\/p>\n

\"Dr.<\/a>

Dr. Mandar Jog, director of the Movement Disorders Program at the London Health Sciences Centre <\/p><\/div>\n

\"Dr.<\/a>

Dr. Ranjit Ranawaya, director of clinical services for the Movement Disorders Clinic at the University of Calgary<\/p><\/div>\n

e-ParkinsonPost raised this issue of non-motor symptoms with Dr. Mandar Jog, director of the Movement Disorders Program at the London Health Sciences Centre and Dr. Ranjit Ranawaya, director of clinical services for the Movement Disorders Clinic at the University of Calgary. Here is some of what they had to say:<\/p>\n

The clinical diagnosis of Parkinson\u2019s disease relies on motor symptoms.<\/strong><\/p>\n

Dr. Jog: \u201cYou need to have two out of the three cardinal symptoms plus response to levodopa. Those are the clinical criteria. You cannot say somebody has Parkinson\u2019s disease because they have constipation, depression, loss of smell or restless leg syndrome. So, if you have a diagnosis of Parkinson\u2019s and you have some of those other things, then those are the non-motor symptoms of Parkinson\u2019s.\u201d<\/p>\n

There is currently no way to tell which people, with non-motor problems, will go on to develop Parkinson\u2019s disease.<\/strong><\/p>\n

Dr. Jog: \u201cIf you have constipation, loss of smell, a family history of Parkinson\u2019s, exposure to well water, if the stars are aligned this way, it may be that you have higher risk of developing Parkinson\u2019s but we don\u2019t go out and screen for those things at this time.\u201d<\/p>\n

Dr. Ranawaya: \u201cThe problem is, if I see a patient with depression or anxiety, how do I know they might get Parkinson\u2019s? At present, we don\u2019t have any drug that will slow down the disease process, stop it in its tracks or stop someone from getting it. However, if we find a compound which does slow down Parkinson\u2019s or stop it, then we would want to identify those individuals who are at risk, possibly by doing smell testing on them. But for now, let\u2019s assume I do a smell test on someone and I realize they could be at risk of Parkinson\u2019s, there\u2019s not much I can do. There really needs to be good evidence that if you start treating a person with medication it\u2019s going to make a big difference in the long run.\u201d<\/p>\n

Many people experience non-motor problems after they have been diagnosed with Parkinson\u2019s.<\/strong><\/p>\n

Dr. Jog: \u201cHaving other associated physical symptoms is not unique to Parkinson\u2019s disease.\u201d<\/p>\n

Dr. Ranawaya: \u201cIn terms of non-motor symptoms, they occur the majority of time after the diagnosis has been made, apart from some people with REM behaviour sleep disorder and a percentage of people with depression or anxiety. The non-motor symptoms accompany the patient with Parkinson\u2019s as the disease progresses.\u201d<\/p>\n

Researchers are discovering that REM sleep behaviour disorder, depression \/anxiety and changes in smell are among the non-motor problems that most commonly precede motor symptoms in Parkinson\u2019s.<\/strong><\/p>\n

Dr. Ranawaya: \u201cStudies by neuropathologist Heiko Braak show that Lewy bodies, a pathological marker for Parkinson\u2019s disease, don\u2019t start in the substantia nigra where dopamine is produced, but they start in the brain stem further down, probably in the autonomic area and in the olfactory bulb which deals with smell.\u201d (The autonomic nervous system controls involuntary body functions.) \u201cThen they ascend to affect the brain stem where we have the sleep\/wake cycle. So many patients develop REM sleep behaviour disorder where they act out their dreams. Then they become Parkinsonian; they develop the motor signs. When the Lewy bodies go further up into the brain, they start affecting the mesolimbic system and the cortex, so that by the time a person develops Parkinson\u2019s, they have probably had it for a long time. For the medical profession, it\u2019s only now we\u2019re recognizing that this is not just dopamine, that there are all these other neurotransmitters that are affected.\u00a0\u00bb<\/p>\n

Dr. Jog: \u201cSome people, including myself, feel that some of these non-motor symptoms are actually symptoms of Parkinson\u2019s. It just happens to have affected other systems earlier on, which makes Parkinson\u2019s not simply a substantia nigra and dopamine disease but a multi-system disease where multiple areas of the body physiologically are involved.\u201d<\/p>\n

Armed with this new knowledge, many clinicians are paying closer attention to the non-motor symptoms of Parkinson\u2019s and seeking ways to assist patients with their treatment and management.<\/strong><\/p>\n

Dr. Jog: \u201cIn the last little while we\u2019ve realized that we need to treat patients more holistically and that symptoms such as swallowing problems, constipation, mild cognitive impairment, even depression, apathy and anxiety are equally important and they do have an impact on the general well-being of patients.\u201d<\/p>\n

Dr. Ranawaya: \u201cIn surveys of patients, we have found that they are more disabled from their non-motor symptoms than their motor symptoms and that these things contribute more to quality of life and are more important to patients. We don\u2019t have remedies for many of the non-motor symptoms so this is becoming quite a conundrum.\u201d<\/p>\n

***<\/p>\n

Practice Parameter: Treatment of nonmotor symptoms of Parkinson disease: Report of the Quality Standards Subcommittee of the American Academy of Neurology<\/a>
\nNeurology 2010;74:924-31.<\/p>\n

***<\/p>\n

Parkinson Society Canada has a checklist <\/a>to help you monitor changes in your Parkinson\u2019s symptoms.\u00a0 Use the checklist to discuss changes with your health care professional.<\/p>\n","protected":false},"excerpt":{"rendered":"

Parkinson\u2019s disease is usually considered to be a movement disorder characterized by tremor, rigidity, slow movement or poor balance. Yet … En savoir plus<\/a><\/p>\n","protected":false},"author":37,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[237],"tags":[],"yoast_head":"\nParkinson\u2019s much more than a movement disorder - Parkinson Canada<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Parkinson\u2019s much more than a movement disorder - Parkinson Canada\" \/>\n<meta property=\"og:description\" content=\"Parkinson\u2019s disease is usually considered to be a movement disorder characterized by tremor, rigidity, slow movement or poor balance. Yet ... 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